The term empty sella syndrome refers to a number of endocrine and/or neurological disturbances that may be caused by the herniation of subarachnoid space within the sella. Empty sella is radiological diagnosis; they need not be symptomatic. The degree of empty sella does not seem to strictly correlate with the severity and/or nature of the clinical picture. Primary empty sella syndrome is a clinical diagnosis supported by radiology. Secondary empty sella is the result of earlier treatment of sellar lesions and does not produce chiasmal herniation or typical empty sella syndrome. Headache and endocrinological symptoms may be managed conservatively. Visual symptoms and CSF rhinorrhea warrant surgical repair (chiasmoplexy).